TY - JOUR
T1 - Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain
AU - Tan, Alai
AU - Zhou, Jie
AU - Kuo, Yong Fang
AU - Goodwin, James S.
N1 - Publisher Copyright:
© 2015, Society of General Internal Medicine.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - BACKGROUND: Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. OBJECTIVE: To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND PARTICIPANTS: Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY RESULTS: Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time. CONCLUSIONS: PCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.
AB - BACKGROUND: Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. OBJECTIVE: To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND PARTICIPANTS: Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY RESULTS: Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time. CONCLUSIONS: PCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.
KW - back pain
KW - care management
KW - practice variation
KW - primary care
KW - quality assessment
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U2 - 10.1007/s11606-015-3475-3
DO - 10.1007/s11606-015-3475-3
M3 - Article
C2 - 26215847
AN - SCOPUS:84955178099
SN - 0884-8734
VL - 31
SP - 156
EP - 163
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 2
ER -